| NPI | 1912384017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VONNCEDRIC LEE DIXON Owener/Manager 844-864-7834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 14432993) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-04-28 |